- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.48 / $3,652.77 / $7,119.04
| Facility | | $1,150.48 | $3,652.77 | $7,119.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $953.00 / $953.00
| Facility | | $953.00 | $953.00 | $953.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.97 / $629.32 / $1,656.79
| Professional | | $331.97 | $629.32 | $1,656.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.52 / $959.29 / $7,155.00
| Facility | | $605.52 | $959.29 | $7,155.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $667.34 / $1,080.73 / $3,508.23
| Facility | | $667.34 | $1,080.73 | $3,508.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $5,327.00 / $8,342.00
| Facility | | $1,770.00 | $5,327.00 | $8,342.00 |